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Utah rates for HCPCS 81404

Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $389.05 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $208.93 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $239.88 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $295.12 / $588.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $501.19 / $1,318.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $269.15 / $346.74
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $575.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $239.88 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $165.96